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Emphasis of reforms
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Subsidy on demand. Radical reform of the health sector with the creation of health provision and health insurance markets. Total separation of the functions of funding, intermediation and provision of services by specialized agents. Social security was transformed by the reforms. |
Subsidy on demand. Reforms aim to create a market for healthcare provision and health insurance but the separation of the funding and provision has not materialized. Co-exists with social insurance. |
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Elegibility/ entitlement
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Those who are unable to pay and who are not part of the formal labor sector are affiliated to the Subsidized Regime (RS) depending on the availability of resources. Workers in the formal labor sector, or who are able to pay, are obliged to join the Contributory Regime (RC). |
People who are not part of the formal work sector (open or uninsured population). Voluntary affiliation. |
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Funding
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RS: combination of national and sub-national fiscal sources, with solidarity contributions equivalent to 1.5% of the mandatory contributions of the RC and of the Armed Forces model, (Ecopetrol). RC: mandatory contributions from workers (4%) and employers (8.5%) in terms of salaries; 12.5% of income of self-employed or those who are able to pay. In 2014 the employer’s contribution for employees earning up to ten minimum wages was replaced by a tax on profits. Co-payments for RC and RS users by income ranges, with exemption for vulnerable groups. |
Combination of fiscal sources from the national government (83%) and states (16%), with mandatory contribution per affiliated family (1%) according to socioeconomic conditions, except for deciles I to IV. No co-payment for services included in the basket. |
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Buying function
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Insurance companies (Health Promotion Enterprises – EPSs) perform financial intermediation and manage risks. In 2014, in the RC there were 17 ICs (15 private and two public), and in the RS there were 35 ICs (24 private, two mixed and nine public). Unit of payment by capitation (UPC), differentiated by RC and RS with gradual equalization. In 1994 the UPC-RS was equivalent to 60% of the UPC-RC, which reached 89% in 2017. |
No insurance providers were established. The intermediation/purchase function is performed by government agencies. |
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Segmentation of social protection (% of populational cover)
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Contributory regime: 46% Subsidized regime: 45% Special schemes: 5% Total population covered: 96% (2016) |
Popular insurance: 49.9%, Social insurance: 46.9% 17% remain without health coverage (2015)* |
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Basket of services
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Obligatory Health Plan (POS): explicit baskets of benefits differentiated for RC and RS. POS-S basket with restricted content and differentiated costing. From 1995-2013 the average RS per capita expenditure corresponded to 33% of the RC expenditure. From 2008-2012 there was gradual equalization of the explicit baskets of RS and RC benefits; however, differences in use and costing persist. From 2015 the service basket became implicit, with a list of exclusions. |
Universal Catalog of Health Services (CAUSES): restricted, explicit basket with 287 interventions (2016); 91% individual and 9% collective. Of the individual interventions 50% were hospital and 40% outpatient. Protection Fund for Catastrophic Spending (FPGC): 61 interventions included only eight types of cancer, HIV/AIDS treatment, treatment for acute myocardial infarction for those aged under 60, and hepatitis C treatment for patients aged 20-50. Complete coverage for care for children up to five years (“Medical insurance for a new generation”). Services not included in the baskets are only accessible through direct payment. |
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Design of the service system
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Does not include a proposal to organize service network; provides for competition between providers. Fragmented services, without territorialization as a result of IC contracts with public and private providers. The supply from public providers is the only one available to the population in dispersed areas |
Does not include a proposal to organize service network. Segmentation and fragmentation of provision of services. Population in dispersed areas with difficulty in accessing services. |
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Health service providers
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Private and public service providers. Transformation of hospitals and public health centers into state-run social enterprises, aiming at revenues from billing services to insured individuals (subsidized demand) and elimination of public on-lending (subsidized supply) with closing of public providers. |
Mainly public service providers from the Health Department (autonomous hospitals and health centers). Contracts are allowed with social and private insurance providers. |
